What you’ll learn
We’ll break down the hormones used in menopause hormone therapy (MHT), including estrogen, progesterone, and testosterone. You’ll learn how each one works, as well as the different forms available for each type of hormone.
Roughly three out of four menopausal women aren’t getting treatment for their symptoms. Not because treatment doesn’t exist, but because they’re either unsure about what their options are or whether hormone therapy is actually safe.
Menopause hormone therapy (MHT) treats hot flashes, night sweats, mood swings, vaginal dryness, and more. It can also help protect your bones as you age. Formerly called hormone replacement therapy (HRT), MHT typically uses estrogen and progesterone, and sometimes testosterone, to supplement and stabilize declining hormone levels during menopause and perimenopause. Since every woman’s body and symptoms are different, the right approach depends on which hormones you need and how you take them.
What hormones are in menopause hormone therapy (MHT)?
Menopausal hormone therapy (MHT) restores the estrogen, progesterone, or testosterone your body makes less of during menopause and perimenopause. The goal isn’t to restore premenopausal hormone levels, but to bring them into a range that gets you feeling more like yourself again. MHT offers benefits like better sleep, steadier moods, more energy, and relief from hot flashes and night sweats.
MHT is safe and effective for relieving menopause symptoms, although it’s not right for everyone. Current guidelines say that for most healthy women who start MHT before age 60 or within 10 years of menopause, the benefits outweigh the risks. If ongoing symptoms are affecting your daily life, these could be signs that you may benefit from MHT.
Let’s unpack each of the different hormones, what they do, and compare how different methods (like patches, creams, and pills) work.
Estrogen
Estrogen is a key hormone for regulating menstrual cycles and supporting bone health, brain function, skin elasticity, and temperature control. Estrogen therapy is considered the most effective treatment for hot flashes and night sweats and can also help with sleep problems, mood swings, and sometimes brain fog.
Estrogen is available in a variety of formats, including:
- Estradiol tablets: Oral tablets are taken once a day and are often the least expensive MHT option. Talk with your provider about your health history to see if this is a good fit.
- Estradiol patches: Estrogen patches are sticky adhesives you apply to your skin once or twice a week. Since the hormones go directly through your skin into your bloodstream, they bypass the liver (meaning fewer system-wide side effects than tablets). Providers usually recommend patches if you start MHT after age 60 or have cardiovascular risk factors.
- Estradiol vaginal inserts: Vaginal inserts provide localized relief from vaginal irritation and bladder problems. Because they target vaginal symptoms with a low dose of estrogen, they have minimal effects on the rest of your body.
- Estradiol vaginal cream: Vaginal creams are applied inside the vagina for localized relief from dryness, discomfort, and irritation. These low-dose creams absorb minimally, which means a lower risk of blood clots.
Progesterone
If you have a uterus and are taking estrogen, you’ll need progesterone too. Estrogen can cause the uterine lining to thicken over time, and progesterone keeps that in check to prevent overgrowth. Progesterone also helps with sleep and steadying your mood, which is why some people feel noticeably better once they add it to their routine.
Progesterone capsules are one of the most common forms used in MHT. They are typically taken at bedtime since they can make you sleepy, which helps with the sleep benefits.
Some women use estrogen and progesterone combination birth control pills to manage irregular bleeding and hot flashes during perimenopause. It’s a different approach than traditional MHT, but it can work well before you transition to menopause hormone therapy later on.
Testosterone
Testosterone supports libido, energy, motivation, and muscle mass. Your levels decline during menopause even if your ovaries are intact. When it drops, your sex drive can evaporate, motivation disappears, and you’re left with fatigue that often gets brushed off as depression or just part of getting older.
Testosterone cream is the most common form prescribed for MHT and can help boost mood, energy, libido, and muscle tone. Most women tolerate it well. Testosterone is a controlled substance, so your provider has to prescribe and monitor your levels to make sure you’re getting the right dose.
Ways of taking menopause hormone therapy (MHT)
Menopause hormone therapy comes in several forms, and the delivery method matters. MHT can act systemically, which means it treats the whole body, or locally, which means it targets a specific area. Systemic routes (pills, patches, gels, sprays) are used for symptoms like hot flashes, mood swings, and night sweats. Local vaginal estrogen is a targeted approach used when systemic therapy isn’t appropriate.
Different delivery methods can also affect the risks of menopause hormone therapy, particularly when it comes to how your body processes the hormones.
Common delivery methods:
- Tablets (oral pills) are taken daily and are usually the most budget-friendly. The downside is that they must be processed by the liver, which can increase the risk of certain side effects for some people.
- Skin patches are applied once or twice weekly. They deliver steady hormone levels, and you don’t have to remember a daily pill. However, some people find they irritate their skin or don’t stick well.
- Topical gels and creams are applied daily to the arms or thighs. They give you flexibility with timing and dosing, but you need to be consistent and careful about skin-to-skin contact with others until it dries.
- Vaginal inserts, tablets, and creams target vaginal dryness and discomfort. When using low-dose vaginal estrogen, very little hormone gets into your bloodstream, so it’s often an option even if systemic hormone therapy isn’t right for you.
Interested in MHT? Talk with QuickMD today
Menopause and perimenopause can make you feel “off,” but you don’t have to tough it out until the ride is over. MHT is one of the most effective treatments for hot flashes and night sweats. It can also help with the mood swings, brain fog, vaginal dryness, and bladder issues that women deal with during this time.
If you’re thinking about exploring your options, our team of doctors here at QuickMD has expertise in helping women take control of their health during this time of life. We’ll work with you to find the right hormones and delivery method based on your symptoms, health history, and what matters most to you.
